The role of hysterosalpingography in cases of subfertility

Subfertility is the inability of a couple to conceive even after one year of regular unprotected coitus. The desire of woman for children is great, sometimes greater than self-interest in beauty and figure and may be stronger than the claims of a career. Considering the social stigma attached to subfertility, a sympathetic and a carefully balanced therapeutic approach to their problem is required.

The present work has been undertaken with a view to asses the role of HSG in the evaluation of subfertility.

For the present study, a total of 105 infertile patients were selected from the outpatient department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Darbhanga. Only those cases were selected where the couples were in the fertile age group of and were living together for two or more years. The patients were advised to take 600 mg ibuprofen, an hour before the procedure to ease the cramps. A catheter was inserted through the cervical canal, and radio-opaque dye (urograffin 76%) was passed through it. A radiograph was taken after injection of two ml. of medium to ensure that there was no filling defect in the uterine cavity which, otherwise, would be concealed by overdistending the uterus. Further injection outlined the Cornua, isthmus and ampullary portions of the tube and evaluated the degree of spillage.

Of the total number of cases, abnormal HSG findings were seen in 55 patients. Majority of the patients were between 26-30 years age group with 6-10 years duration of subfertility. The tubes were occluded in 34.28% of cases in the ratio of 1:8, proximal occlusion being the commonest. 5.71% showed hydrosalpinx. Beaded & wiry appearances of tubes were seen in 2.85% of cases. Amongst the uterine anomalies, which accounted for 20% of cases, only five patients had acquired abnormality. In the congenital group maximum number of patients had hypoplastic uterus (52.38%) followed by bicornuate uterus. Unicornuate and arcuate uterus accounted for 9.52% each. Intravasation of contrast occurred in two patients.

Hysterosalpingography plays an important role in the initial diagnostic assessment of female subfertility. Other than being diagnostic, it can prove to be therapeutic also. An accurate interpretation of the hysterosalpingogram is necessary for the initial subfertility workup. Knowledge of these entities is important to avoid the practice of unnecessary and sometimes more aggressive procedures.